Author Topic: Insurance Coverage for Eye Weight?  (Read 7566 times)

psmix

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Insurance Coverage for Eye Weight?
« on: April 20, 2011, 02:06:06 pm »
Can any of you with insurance through Blue Cross Blue Shield comment on coverage for eye weights and other related procedures? I'm planning to start with an external weight, and may consider an implanted weight down the line. Blue Cross told me that it would have to be submitted for pre-authorization to determine medical necessity. I'm not too concerned about coverage for the Blinkeze, since I think that's relatively inexpensive, but I would hope they would cover other, more expensive procedures if I need them. I know that specific policies differ, but would be interested in your experience.

Thanks.
Pam
Right AN diagnosed Sept. 2010 - 4 cm x 3 cm x 3 cm
Debulked via translab Sept. 2010
Removed at House Feb. 2011
CSF leak with blind sac closure and lumbar drain March 2011
Unresponsive facial nerve, platinum weight
SSD

Brewers7

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Re: Insurance Coverage for Eye Weight?
« Reply #1 on: April 20, 2011, 02:53:40 pm »
BCBS covered my weight.
Translab surgery 12/15/2008 followed by CSF leakage repair and 3 additional surgeries for MRSA of the brain (NOT typical) SSD,  facial and vocal cord paralysis, numerous reconstructive surgeries, Transear 12/2010

Kaybo

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Re: Insurance Coverage for Eye Weight?
« Reply #2 on: April 20, 2011, 03:49:41 pm »
I don't have BCBS, but in my experiences, they ate more willing to do the major implants/surgeries than the little, much more inexpensive things!

;D
Translab 12/95@Houston Methodist(Baylor College of Medicine)for "HUGE" tumor-no size specified
25 yrs then-14 hour surgery-stroke
12/7 Graft 1/97
Gold Weight x 5
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Facial Paralysis-R(no movement or feelings in face,mouth,eye)
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PaulaT

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Re: Insurance Coverage for Eye Weight?
« Reply #3 on: April 28, 2011, 08:24:21 am »
Would it hurt anything to submit it for preauthorization? Is there any costs involved to have your doctor submit for preauthorization? They'll either approve it or not approve it but you don't have to commit to it before preauthorization do you?
« Last Edit: May 04, 2011, 04:49:11 pm by PaulaT »

lori67

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Re: Insurance Coverage for Eye Weight?
« Reply #4 on: April 28, 2011, 11:06:09 am »
There won't be any cost to do a pre-authorization.

My eye surgeon in TN said that none of the insurance companies he had worked with would cover the Blink-eze, but I know they cover the implanted weights.  Now, this was 2 years ago, so things might have changed.  He was actually on a committee at that time to get the insurance companies to cover the external weights because that just really got him fired up.  I can see why, if a patient needs it, insurance shouldn't be denying coverage for it.

But, the worst they can say is "no", so I would go ahead and ask.  You won't have to commit to anything - the doctor would have to file an actual claim when the procedure is done before insurance would cover it anyway.

Good luck!
Lori
Right 3cm AN diagnosed 1/2007.  Translab resection 2/20/07 by Dr. David Kaylie and Dr. Karl Hampf at Baptist Hospital in Nashville.  R side deafness, facial nerve paralysis.  Tarsorraphy and tear duct cauterization 5/2007.  BAHA implant 11/8/07. 7-12 nerve jump 9/26/08.

psmix

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Re: Insurance Coverage for Eye Weight?
« Reply #5 on: May 06, 2011, 09:30:10 pm »
BCBS did approve coverage for the external weight. I'm glad they made a logical decision, since the external weight is the cheaper option!
Right AN diagnosed Sept. 2010 - 4 cm x 3 cm x 3 cm
Debulked via translab Sept. 2010
Removed at House Feb. 2011
CSF leak with blind sac closure and lumbar drain March 2011
Unresponsive facial nerve, platinum weight
SSD

Jim Scott

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Re: Insurance Coverage for Eye Weight?
« Reply #6 on: May 07, 2011, 12:57:42 pm »
BCBS did approve coverage for the external weight. I'm glad they made a logical decision, since the external weight is the cheaper option!

Pam ~

Thanks for letting us know how that insurance question worked out.  Congratulations!

Jim
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.